Prognosis for Rehnquist Depends on Which Type of Thyroid Cancer He Has

By LAWRENCE K. ALTMAN

Published: October 26, 2004

The prognosis for William H. Rehnquist, the 80-year-old Supreme Court chief justice who is being treated for thyroid cancer, depends on the specific type of cancer he has, thyroid experts said in interviews yesterday.

The Supreme Court released no information about the pathologic findings or how the disease is being treated beyond saying Chief Justice Rehnquist needed a tracheotomy. That surgical procedure involves cutting a hole into the trachea, or windpipe, to aid breathing.

Because a tracheotomy is not part of routine thyroid cancer surgery, the experts, who were not involved in Chief Justice Rehnquist's case, said they were puzzled why he needed one. The Supreme Court did not say whether the chief justice underwent a thyroidectomy, a surgical removal of the thyroid gland and a common treatment for thyroid cancer.

An estimated 23,600 new cases of thyroid cancer will be detected this year in the United States, mostly in women, the American Cancer Society says.

The thyroid is a hormone-producing gland that is in front of the trachea in the neck. Cancers affecting it are often detected when a doctor feels a nodule, or bump, in examining the thyroid. Such cancers may also come to attention when an individual's voice becomes hoarse, as observers said Mr. Rehnquist's has been in recent weeks.

Of the four main kinds of thyroid cancer, the papillary type is by far the most common. The cure rate is about 95 percent among younger people. But among older people, the cure rates for papillary thyroid cancer are often lower.

A second type, follicular, accounts for about 15 percent of thyroid cancers, and its prognosis is not as favorable as the one for papillary thyroid cancer. Two less common types are anaplastic and medullary thyroid cancers.

Anaplastic thyroid cancer is nearly always fatal and generally runs a rapid course, said Dr. Braverman, editor of a leading textbook on thyroid disease. Medullary thyroid cancers can be familial and is often more aggressive than papillary and follicular. Rarely, a different kind of cancer, lymphomas, can develop in thyroid glands.

The need for a tracheotomy in the chief justice's case implies a number of possibilities, said Dr. Paul W. Ladenson, a thyroid expert at the Johns Hopkins University in Baltimore who is president of the American Thyroid Association. One is that the cancer was squeezing on the windpipe, impairing breathing.

Another is that the two recurrent laryngeal nerves that control the voice box were accidentally or purposely cut in surgery or that the cancer had spread to invade the nerves, Dr. Ladenson said. He also said the fact that Chief Justice Rehnquist's voice recently became hoarse suggests that the problem may have resulted from an invasion of the nerves. In such cases, a tracheotomy may be needed to help a thyroid cancer patient speak.

Still another possibility is that Chief Justice Rehnquist may have needed a tracheotomy because of lung damage that resulted from being a longtime smoker.

The court did not say whether the tracheotomy was temporary or permanent. Because it usually takes some time for patients to adapt to a tracheotomy and to care for it, like learning to clean it to avoid blockage and infections, the experts said they were surprised that Chief Justice Rehnquist was expected to return to the court next Monday.

Chart: ''The Thyroid And the Trachea''
William H. Rehnquist, the chief justice of the United States, was recently told he had thyroid cancer. He underwent a tracheotomy, a procedure that involves opening a hole into the trachea to aid breathing.